Kiyoshi Hashiba

Role of upper gastrointestinal endoscopy with routine standardized endoscopic biopsy in AIDS

The purpose of this study is to identify lesions in the esophagus, stomach and duodenal bulb in patients with AIDS through endoscopy, and to correlate the results obtained with the histophatological study of standardized endoscopic biopsies of the esophagus, stomach and duodenal bulb.

Endoscopic treatment for gastric perforation using T-tag and a plastic protection chamber: a short-term survival study

CONTEXT The endoscopic gastric perforation is a consequence of some endoscopic procedures and now a way to manage abdominal organs. This is the reason why endoscopists are studying a safe endoscopic repair. OBJECTIVE To evaluate an endoscopic closure method for the gastric opening in natural orifice transenteric surgery DESIGN Short-term survival animal study. METHODS Ten White Landrace pigs underwent a gastric perforation of 1.8 cm in diameter under general anesthesia. The opening was repaired with stitch assembled in a T-tag anchor placed through the gastric wall with a needle. A plastic transparent chamber, adapted to the endoscope tip protected the abdominal organs from the needle puncture outside the stomach. Six T-tags were placed in most cases and the stitches were tied with a metallic tie-knot, forming three sutures. The animals received liquids in the same operative day. One shoot antibiotic was used. The leakage test was performed with a forceps and by air distention. RESULTS No complication was detected in the postoperative course. One month later the endoscopy revealed a scar and some suture material was observed in all animals. The antral anterior gastric wall was clear with few adhesions in the laparotomy performed in the same time. The adhesions were intense in an animal in which a cholecystectomy was performed before the repair. CONCLUSION The endoscopic repair using T-tag and a protector chamber is feasible, easy to perform and safe. Further studies are needed to show the real value of this kind of procedure.

Expandable Gastric Port for Natural Orifice Translumenal Endoscopic Surgery

BACKGROUND The risk of intraabdominal contamination is a critical consideration during most natural orifice translumenal endoscopic surgery (NOTES) procedures. OBJECTIVE The objective of this study was to determine a safe and efficient pathway for the endoscope in a transgastric NOTES procedure. DESIGN AND SETTINGS A pilot experimental study in live pigs was performed. METHODS Five White Landrace pigs, weighing approximately 30-35 kg, underwent the placement of a device consisting of an expandable sheath, the distal portion of which was composed of a fully covered self-expanding metal stent, and an introducer made with an outer catheter, a pushing catheter, and an inner, guiding catheter. The sheath was attached to the stent by suturing it in place. The initial gastric opening was made by means of a needle knife papilotome with electrocoagulation, aimed to the anterior gastric wall. Then, it was dilated with an endoscopic 1.8-cm balloon. The set was introduced over a Savary guidewire. After the set placement, the outer tube was slowly retrieved. Finally, the delivery system was removed from the pig, leaving the entire endoscopic port in place. RESULTS The expandable gastric port was placed without difficulty in all animals. Endoscope insertion into the expandable gastric port was very easily performed. The endoscope had a wide range of movement inside the peritoneal cavity. The gastric port sealed the gastric wall, avoiding gross contamination of the peritoneal cavity and maintaining the pneumoperitoneum without excessive inflation of the intestine. CONCLUSIONS Use of a gastric port can minimize contamination of the peritoneal cavity due to the spillage of gastric contents during a transgastric NOTES procedure and can also facilitate performance of the procedure.

Endoscopic treatment of esophageal varices, using pretied loop made with polyamide thread

BACKGROUND [corrected] The elastic band ligation is the method of choice for treatment of esophageal varices. The action mechanism is a mechanical varices compression with thromboses. Based on this concept we developed a ligature method using pretied loop made with polyamide thread for the treatment of esophageal varices. OBJECTIVE The present study describes and evaluates the feasibility of the treatment of esophageal varices by the ligature method using pretied loop made with polyamide thread and analyzes the local changes of the ligations and the results, concerning safety, efficiency and complications of this procedure. PATIENTS AND METHODS Between March, 1998 and May, 2000, 58 patients with esophageal varices were treated with pretied loop, made with polyamide thread (26 patients with schistosomiasis, 11 with alcoholic cirrhosis, 9 with hepatitis C, 5 with hepatitis B, 4 of unknown etiology, 2 with hepatitis B and C, and one with Budd-Chiari syndrome/ 42 men and 16 women/ average age of 47,67 +/- 13,12 years, range 16-74). A plastic tube was attached to the endoscope tip featured as an accessory working channel, allowing the pretied loop made with polyamide thread to be conducted to the esophagus facilitated by a flexible metallic tube, to perform the esophageal varices ligature. A total of 506 ligatures were done, distributed in 223 sections (average of 2,26 +/- 1,08 ligature, varying from 1 to 6 per section). The sessions were perform with the interval of 15 days, until the complete eradication of the esophageal varices. The ecoendoscopy was used as a complementary method to evaluate the varices eradication RESULTS The esophageal varices were treated successfully in all patients. The complete eradication of varices was achieved in 47 (81,03%) patients. In 37 (63,79%) patients the ligatures resulted in pseudopolyps. It was not identified systemic complications or obits. The ecoendoscopy showed thrombosis in the pseudopolyps of 10 patients. The follow-up period was from 4 to 32 months and recurrence of the esophageal varices was observed in 9 (15,51%) patients. The average cost of each ligature was estimated in US

An Alternative Procedure for Endoscopic Sphincterotomy in Patients with Billroth II Gastrectomy

1,00. CONCLUSION The study indicates that endoscopic treatment using polyamide thread ligature is a safe, efficient, accessible and low cost method for treatment of esophageal varices treatment, demonstrating a new aspect, that is the obliteration of varices without necrosis, by formation of pseudopolyps.

FULL-THICKNESS ENDOSCOPIC GASTRIC RESECTION USING A STAPLER AND GASTROSTOMY: A FEASIBILITY STUDY

An EST was performed on 33 patients with choledocholithiasis and a previous Billroth II gastrectomy according to an alternative technique, using a cannula as a cutting guide. This seems to be an easy and safe technique which may be used in cases in which the deep cannulation of the common bile duct is possible.

3471 Guideline for gastric perforation endoscopic repair using metallic clips.

ABSTRACT Background: Laparoscopic sleeve gastrectomy (LSG) is currently the most frequently performed bariatric procedure in Turkey. The goal of weight reduction surgery is not only to decrease excess weight, but also to improve obesity related comorbidities and quality of life (QoL). Aim: To evaluate the impact of LSG on patient quality of life, weight loss, and comorbidities associated with morbid obesity according to the updated BAROS criteria. Methods: Eleven hundred thirty-eight adult patients were undergone to LSG by our bariatric surgery team between January 2013 and January 2016. A questionnaire (The Bariatric Analysis and Reporting Outcome System - BAROS) was published on social media. The data on postoperative complications were collected from hospital database. Results: Number of respondants was 562 (49.4%). Six of 1138 patients(0.5%) had leakage. All patients who had leakage were respondants. The overall complication rate was 7.7%. After a mean period of 7.4±5.3 months(1-30), mean excess weight loss was 71.3±27.1% (10.2-155.4). The respondants reported 772 comorbidities. Of these, 162 (30%) were improved, and 420 (54.4%) were resolved. The mean scores for QoL were significantly increased after LSG (range, p<0.05 to <0.001). Of the 562 patients, 26 (4.6%) were classified as failures; 86 (15.3%) fair; 196 (34.9%) good; 144 (25.6%) very good, and 110 (19.6%) excellent results according to the updated BAROS scoring system. Conclusion: LSG is a highly effective bariatric procedure in the manner of weight control, improvement in comorbidities and increasing of QoL in short- and mid-term.

2216 Endoscopic gastric perforation repair with omental patch, using endoscopic clips.

Introduction- Perforation of the digestive tract wall is one of the most feared complications in endoscopic resections of epithelial or subepithelial lesions. Aims - Evaluation of an experimental endoscopic closure of gastric perforations on pigs and establishment of guidelines for endoscopic closing sutures. Method-Ten pigs of races Landrace and Large-White were submitted to general anesthesia and upper GI endoscopy. Initially a standardized gastric wall perforation was performed. The opening was made by aspiration of the gastric wall with an end adapter used for rubber band ligation. The resection of the adapter content was performed with a polypectomy snare introduced through a plastic tube attached to the endoscope. As a next step, a metallic endoscopic clip (Hemoclip® - Olympus America Inc., Miami FL ) was placed on the edge of the opening, grasping firmly the muscular layer. After having trapped the clip, the polypectomy snare was pulled through the mouth so as to bring the wound to a spindleshaped form. The closure was achieved by clips placed one by one. Where the muscular layer could not be seen, the closure was made with the mucosa, aiming to catch the wall as deeply as possible. The pneumoperitoneum was emptied with a Verres needle. The animals were sacrificed after 15 days and had their stomach removed for macro and microscopical study. At the same time, the abdominal cavity was evaluated. Results - The suture was performed in all animals, but in only seven (7) of them was the muscular layer clearly attached to both sides of the wound. Nine (9) pigs showed the opening edges firmly coapted and five (5) had an ulcer at the site of the wound. Three pigs appeared to be ill in the postoperative course and showed localized or generalized peritonitis. One (1) died on the 13th day. Conclusions - The endoscopic repair of gastric perforation using clips seems to be feasible and easy. It seems useful to establish some guidelines. After aspiration of gastric contents, the first step would be to work the wound into the shape of a mouth. This strategy will make it easy to clip the edges. It is very important to make the suture grasp the muscular layer. More studies are needed before this technique is used routinely in patients.

7240 Is the opening of the biliary duct without electrocoagulation, in infundibulotomy, important to avoid complications?

INTRODUCTION - Perforation of the digestive tract wall is a complication of some therapeutic procedures. In such an event, the endoscopic repair is less invasive and its performance has been reported in several cases. On the other hand, the idea of using an omental patch for such repairs has been applied for a long time to the surgical treatment of gastroduodenal ulcer perforation. This study shows the results of combining both techniques and allows to establish a guideline for this kind of repair. METHOD -Ten threecross Large White, Landrace and Pietan pigs were submitted to a standardized gastric perforation procedure by aspiration and cutting, for which a polypectomy snare and an end adapter for endoscopic esophageal varices ligation were used. The omentum (OM) was pulled to the gastric cavity in most cases by aspiration with the endoscope) and then caught with the metallic snare and fixed to the muscular layer of the stomach by endoscopic metallic clips. By changing the position of the snare it was possible to place the clips in any convenient position. This procedure was carried out under general anesthesia. The animals received food on the first day after the operation. They were sacrificed on the 15th postoperative day. RESULTS - Nine animals had a normal postoperative course. In all of them, an ulcer could be seen at the repaired site. On the external side of the wall, the OM was adherent. No other alterations were observed in the peritoneal cavity. The gastric wall histology showed a moderate inflammatory process in these pigs. In one animal whose muscular layer could not be seen during the procedure, the clips attached the OM to the mucosa. This animal died on the 11th postoperative day. Examination of the peritoneal cavity at sacrifice revealed intense peritonitis. The perforation was not repaired in this animal. CONCLUSION - This seems to be a simple and easy technique for EGPR, as safe as the conventional surgery.With the use of antibiotics, the risk of infection could be considered acceptable, especially in view of the advantages offered by a less invasive procedure. It seems to be important to attach the omentum to the muscular layer. The EGPR with a patch of OM seems to be an interesting option to be confirmed by further studies.

7075 A new technique for endoscopic polipectomy of the colon.

Electrocoagulation is used for opening the biliary duct in alternative procedures aiming at deep cannulation of the CBD and it seems to be the source of some complications. The dissection of the biliary duct in the papilla allows this duct to be opened by a sharp instrument or forceps without the use of electrocoagulation.This study deals with this different endoscopic access to the CBD. Methods - From January 1993 to December 1998, 1081 patients were referred to ERCP. In 24 of these patients, cannulation was not attempted or deep cannulation was not successful either because the papilla could not be reached or because it showed benign or malignant alterations. In the remaining 1057 patients, cannulation was attempted. The standard deep cannulation of the common bile duct (CBD) was achieved in 1008 (95.36%) and failed in 49 patients. From this latter group, 48 patients underwent an alternative procedure aimed at achieving deep cannulation: endoscopic dissection of the distal biliary duct. In four of them the opening was achieved without electrocoagulation: in two of these cases, a needle was used; in the other two, a forceps. Results - No complications of ERCP occurred in the postoperative course. Cholangiography having revealed choledocholithiasis in three patients, papillotomy and clearance of CBD complemented the procedure. In only one patient the amilasemia level was determined and found normal. The other patient had a normal X-ray image. Conclusion - The endoscopic dissection of the biliary duct in the major duodenal papilla is a procedure performed under visual control and permits to open the duct with mechanical maneuvers. The fact that no electrocoagulation is used can avoid some complications like pancreatitis.Opening the biliary duct in the major papilla without electrocoagulation can be the best option for cholangiography when an alternative procedure is required to achieve deep cannulation of the CBD.